Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions.

BACKGROUND: Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. METHODS: Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. RESULTS: The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p < 0.01; SF-12 MCS: 59.4% versus 74.3%, p < 0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182-5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. CONCLUSIONS: Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

A single case report of recurrent surgery for chronic back pain and its implications concerning a diagnosis of Münchausen syndrome.

While undergoing treatment in the psychiatric department, A.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrollable anxiety attack and in a state of fluctuating consciousness, was found to be suffering from a psychopathological condition characterized by pathological lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple invasive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slow-discharge morphine pump and the patient being granted a full disability pension. The continual increases in the doses of morphine suggested a tendency towards drug addiction. After providing a brief overview of the historical background and current concepts relating to the relationship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of Münchausen syndrome (the hypothesis best supported by the clinical evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not frequently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact.

[Suicidal behavior in the North Varese province: a epidemiological analysis]. / La condotta suicidaria nel nord della provincia di Varese: un'indagine epidemiologica.

OBJECTIVE: Analysis of figures and characteristics of suicide behaviour in the area of Varese and the neighbouring northern towns (Valceresio, the valleys around Luino and northern Verbano), with the purpose of finding out preventing measures. DESIGN: Epidemiological-descriptive survey. The 1995-1997 ISTAT death cards, included in the death files of the former USSL of Varese have been taken into consideration. Only those people who were resident at the suicide moment have been included in the survey. Afterwards the psychiatric service archives were consulted, to find any possible contact between the subjects in the ISTAT files and the psychiatric services themselves. With regard to these patients, some information such as suicide attempts, psychiatric pathology and first contact with the psychiatric services have been pointed out. SETTING: Arcisate, Cittiglio, Luino and Varese districts, where the Community Mental Health Services 1 and 2 of "Azienda Ospedaliera Universitaria Macchi" of Varese operate. MAIN OUTCOME MEASURES: The suicide rates in the studied area have been reckoned and, through direct standardization, the rates of the single districts have been compared. RESULTS: There were 78 suicides (24 females and 54 males): rate of 8.2 per 100,000. In accordance with the national trend, there is evidence of a general reduction of the suicide phenomenon, except among the youngest. Districts of Luino and Arcisate are geographic areas to examine in the time, because a wider sample could reveal a higher risk. Young and elderly people are the most affected among the males and, 55/64-year-old people, both males and females, are at higher risk. Suicide methods vary with the age. A high percentage of subjects are not married and with low education. Less than one third of the subjects had come into contact with the psychiatric service. CONCLUSIONS: These data allow a comparison with the national survey and an analysis of the suicide features in the study area. The purpose is to elaborate preventing strategies with multi-dimensional approach whose efficacy may be proved in the future by setting up a provincial observatory.

Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study.

The 20-item Toronto Alexithymia Scale (TAS-20) has been shown in previous research to measure a general dimension of alexithymia with three intercorrelated factors. This study evaluated the reliability and factorial validity of an Italian translation of the TAS-20 in a group of normal adults (N = 206) and in a mixed group of medical and psychiatric outpatients (N = 642). Using confirmatory factor analyses, the previously established three-factor model of the TAS-20 was found to be replicable in both groups. In addition, the Italian TAS-20 demonstrated adequate estimates of internal reliability and test-retest reliability. Although evaluation of the convergent, discriminant, and concurrent validity of the TAS-20 is required in Italian populations, the present results support the use of the Italian translation of the scale for clinical and research purposes.

[Recalling the acute psychotic experience]. / Die Erinnerung an die akute psychotische Erfahrung.

In this study we have analysed the memory of the acute psychotic experience in chronic schizophrenics to evaluate the influence of memory on present symptomatology. We briefly examine the literature on this subject, then we describe some clinical cases trying to give a sense to the different way of "recovery", in schizophrenics. In particular we note that sensorial events of the acute psychotic experience have an important role in memory. Besides this study deepens some particular aspects of memory in schizophrenics.

[Primary care and psychoactive drugs. Some reflections]. / Medico di base e psicofarmaci. Alcune riflessioni.

This paper aims at defining some problems that are present in the prescribing of psychotropic drugs in general practice. An important proportion of the patients in the primary care have psychological and/or clear psychiatric disorders; therefore it is necessary for the general practitioners to understand their needs, but also overuse or misuse of psychoactive drugs. The rational use is discussed and some considerations and instructions are stated.

[Changes in CSF dynamics and performance tests after head injuries (author's transl)]. / rapporti fra le modificazioni della dinamica liquorale e le prestazioni a tests neuropsicologici nei traumatizzati cranioencefalici.

In a large series of head-injured patients (132 cases), we have selected 30 patients (mean age 43 years) with only primary school education: they have been investigated with isotope cisternography and psycodiagnostic tests. 19 underwent neurosurgical procedures (6 extradural haematomas, 8 subdural haematomas, 5 cerebral lacerations). These investigations have been carried at least six months after the head injury. We have used for isotopic cisternography RISA and In111-DTPA. Raven's Progressive Coloured Matrices and Immediate Memory Tests were performed. Cisternographic pictures were classified as 1) normal, 2) with asymmetrical diffusion, 3) with ventricular reflux and were correlated with the neuropsychological data. We have found ventricular reflux in 10 patients (5 underwent surgical procedures), asimmetrical diffusion in 15 patients (11 operated); in 5 cases cisternographic pictures were normal. Neuropsychological tests give quantitative data about progressive mental deterioration, in full agreement with cisternographic results.